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SUMMARY: Halicioglu O, Asik-Akman S, Yaprak I, Astarcioglu G, Imamoglu T, Reisoglu A. Physiological periostitis in a 2.5-month-old baby. Turk J Pediatr 2009; 51: 305-307.
Periosteal reaction has different etiologies in early infancy. Physiological periostitis is a well-documented X-ray finding seen in both preterm and term babies aged between 1-6 months and can easily be misdiagnosed as child abuse or pathological periostitis. Here, we present a 2.5-month-old infant admitted with a history of fever, swollen right upper arm after vaccination and X-rays findings revealing periosteal reactions on both sides of the humeri, radii, tibiae and femora. Initial diagnosis was child abuse or congenital syphilis. Due to the normal physical findings and normal serological-biochemical data, physiological periostitis was diagnosed. Physiological periostitis should also be considered in patients with periosteal reactions of the long bones in infants aged between 1-6 months.
Key words: periostitis, physiological, infant.
Physiological periostitis (or periosteal new bone formation) is a known radiological finding in both preterm and term infants aged between 1 and 6 months, and the exact etiology of this condition is unknown. It is commonly seen in long bones and is invariably symmetrical in distribution, although occasionally more prominent on one side than the other. The femora, humeri and tibiae are affected almost equally, but may be limited to one pair of bones initially. It is always on the diaphysis and usually asymptomatic1. In the differential diagnosis of periosteal reaction, it can be confused with other causes of pathological periostitis such as child abuse, syphilis, osteomyelitis, trauma, bone tumor and tumor-like lesion; thus, radiological analysis must be done carefully2-3. In the literature, there are few case reports about physiological periostitis. It is a condition that should be known well in order to avoid more aggressive laboratory testings of infants. We therefore report this case to call the attention of physicians to this self-limited condition.
Case Report
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